title: Does access to comprehensive outpatient care alter patterns of emergency department utilization among uninsured patients in East Baltimore?
abstract: BACKGROUND
  The annual number of emergency department (ED) visits in the United States increased 23% between 1997 and 2007. The uninsured and those with chronic medical conditions are high users of emergency care.
  
  
  OBJECTIVE
  We sought to determine whether access to comprehensive outpatient primary and specialty care and care coordination provided by The Access Partnership (TAP) reduced ED utilization among uninsured patients relative to patients who chose not to enroll.
  
  
  METHODS
  Multiple time series analysis was performed to examine rates of ED utilization and inpatient admission among TAP patients and a comparison group of eligible patients who did not join (non-TAP patients). Monthly ED utilization and inpatient admission rates for both groups were examined prior to and subsequent to referral to TAP, within a study period 2007-2011.
  
  
  RESULTS
  During the study period, 623 patients were eligible to enroll, and 374 joined the program. Rates of ED visits per month increased in both groups. Compared with non-TAP patients, TAP patients had 2.0 fewer ED visits not leading to admission per 100 patient-months post-TAP (P = .03, 95% confidence interval = 0.2-3.9). TAP status was a moderate predictor of ED visits not leading to admission, after controlling for age, gender, and zip code (P = .04, 95% confidence interval = 0.1-3.9).
  
  
  CONCLUSIONS
  Although overall ED utilization did not change significantly between program participants and nonparticipants, TAP patients had a lower rate of ED visits not resulting in inpatient admission relative to the comparison group.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. lblock6@jhmi.edu
authors.forename: Lauren
authors.initials: L
authors.lastname: Block
authors.forename: Sai
authors.initials: S
authors.lastname: Ma
authors.forename: Matthew
authors.initials: M
authors.lastname: Emerson
authors.forename: Anne
authors.initials: A
authors.lastname: Langley
authors.forename: Desiree de la
authors.initials: Dde L
authors.lastname: Torre
authors.forename: Gary
authors.initials: G
authors.lastname: Noronha
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration*; D015142:Baltimore; D002908:Chronic Disease; D003191:Comprehensive Health Care / Q000191:economics / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007373:Interinstitutional Relations; D016014:Linear Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D019982:Organizational Case Studies; D010343:Patient Admission / Q000191:economics / Q000639:trends*; D062526:Patient Navigation / Q000191:economics / Q000379:methods / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration; D013038:Specialization
keywords: access to care; emergency care; health care delivery; primary care; uninsured